Deep anesthesia: too much of a good thing?

Chan, Matthew T. V.; Chu, Mandy H.M.; Lam, Carmen; Jia, Bo; Tsang, Sharon; Wu, William Ka Kei

doi:10.1007/s12630-017-0871-7

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…Now, however, there is increasing public concern about awareness under anesthesia [18,19]. The anesthesia literature suggests that we want our patients to be anesthetized but 'not too deep' [20][21][22]. DOH monitors will be seen in NORA locations more frequently in the coming years.…”

Section: Monitoringmentioning

confidence: 99%

Nonoperating room anesthesia education

Boggs

Luedi

2019

Current Opinion in Anaesthesiology

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Purpose of review Nonoperating room anesthesia (NORA) is the fastest growing segment of anesthetic practice. This review provides an overview of knowledge and trends that will need to be introduced to residents as part of their education. Recent findings Topics for the future include, but are not limited to, new medications, artificial intelligence and big data, monitoring depth of hypnosis, translational innovation and collaboration, demographic changes, financial driving forces, destination hubs, medical tourism, and new approaches to education training and selfmanagement.

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Section: Monitoringmentioning

confidence: 99%

Nonoperating room anesthesia education

Boggs

Luedi

2019

Current Opinion in Anaesthesiology

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Who is a high-risk surgical patient?

Bose

Talmor

2018

Current Opinion in Critical Care

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Purpose of review Timely identification of high-risk surgical candidates facilitate surgical decision-making and allows appropriate tailoring of perioperative management strategies. This review aims to summarize the recent advances in perioperative risk stratification. Recent findings Use of indices which include various combinations of preoperative and postoperative variables remain the most commonly used risk-stratification strategy. Incorporation of biomarkers (troponin and natriuretic peptides), comprehensive objective assessment of functional capacity, and frailty into the current framework enhance perioperative risk estimation. Intraoperative hemodynamic parameters can provide further signals towards identifying patients at risk of adverse postoperative outcomes. Implementation of machine-learning algorithms is showing promising results in real-time forecasting of perioperative outcomes. Summary Perioperative risk estimation is multidimensional including validated indices, biomarkers, functional capacity estimation, and intraoperative hemodynamics. Identification and implementation of targeted strategies which mitigate predicted risk remains a greater challenge.

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Electroencephalography

Chan

Hedrick

Egan

et al. 2020

Anesthesia &Amp; Analgesia

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Electroencephalographic (EEG) monitoring to indicate brain state during anesthesia has become widely available. It remains unclear whether EEG-guided anesthesia influences perioperative outcomes. The sixth Perioperative Quality Initiative (POQI-6) brought together an international team of multidisciplinary experts from anesthesiology, biomedical engineering, neurology, and surgery to review the current literature and to develop consensus recommendations on the utility of EEG monitoring during anesthesia. We retrieved a total of 1023 articles addressing the use of EEG monitoring during anesthesia and conducted meta-analyses from 15 trials to determine the effect of EEG-guided anesthesia on the rate of unintentional awareness, postoperative delirium, neurocognitive disorder, and long-term mortality after surgery. After considering current evidence, the working group recommends that EEG monitoring should be considered as part of the vital organ monitors to guide anesthetic management. In addition, we encourage anesthesiologists to be knowledgeable in basic EEG interpretation, such as raw waveform, spectrogram, and processed indices, when using these devices. Current evidence suggests that EEG-guided anesthesia reduces the rate of awareness during total intravenous anesthesia and has similar efficacy in preventing awareness as compared with end-tidal anesthetic gas monitoring. There is, however, insufficient evidence to recommend the use of EEG monitoring for preventing postoperative delirium, neurocognitive disorder, or postoperative mortality.

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Deep anesthesia: too much of a good thing?

Cited by 3 publications

References 31 publications

Nonoperating room anesthesia education

Nonoperating room anesthesia education

Who is a high-risk surgical patient?

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Electroencephalography

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